News & Views

Rebecca Graham, human resources and organizational-development director of UCLPartners, in London, writes about how UCL, one of the world’s largest academic health science partnerships, helps develop leaders.

“At both the system level and the organization level, we need leaders who can make decisions based on what is best for the population, which is not always the same as what is best for their organization.”

“Effective leaders for UCLPartners must have, in addition to the usual suite of leadership skills, an ability to foster cooperation among our member organizations. We must select clinicians to lead system-wide transformation and improvement, and to do so, we introduced a competency-based approach that evaluates candidates for a wide spectrum of personal characteristics and capabilities, rather than relying on the more traditional criteria of seniority, length of experience, and reputation.”

“At both the system level and the organization level, we need leaders who can make decisions based on what is best for the population, which is not always the same as what is best for their organization. ”

“(Our reconfiguration of stroke care in north central London is a good illustration of how the clinical evidence and patient benefit started to drive a new type of behavior in the system — looking at what can be achieved as a system rather than individual clinicians or organizations.)”

The Hill reports that Federally Qualified Health Centers are nervously making make contingency plans as they wait to see if Congress will renew billions of dollars in federal funding that expired on Sept. 30.

The clinics provide care to some 26 million of America’s most vulnerable people. They must treat any patient who seeks care, regardless of whether they can pay. The Feds cover 70 percent of their costs.

The Hill reports that some of the centers have imposed hiring freezes and are having trouble recruiting and retaining employees.

“North Carolina wants to entice more providers to treat its Medicaid population by paying off their debts. The state is also looking at imposing premiums and work requirements on Medicaid enrollees. The proposals were made in an amendment to the state’s pending Medicaid waiver that would allow it to shift the program from fee-for service to managed care by 2019. The policy suggestions are also coming at a time when some state lawmakers are mulling Medicaid expansion.”

A New York Times article reviews the growing phenomenon of hospitals, insurers and drugstores teaming up to try to prosper in the turbulent healthcare world.

The paper says “They are also bracing for the threats posed by interlopers like Amazon eyeing a foray into the pharmacy business or tech companies offering virtual medical care via a computer or cellphone.”

“’There’s been a strong trend for health organizations to want to broaden their footprint, especially on the part of insurers to get more direct contact with the individual,” Dr. John W. Rowe, a former hospital and insurance executive who is a professor of health policy at Columbia University, told The Times

The Centers for Medicare & Medicaid Services has announced that it is adding 13 more hospitals to its Rural Community Hospital program, joining 17 other participating hospitals. The pilot program reimburses hospitals for the actual cost of inpatient care rather than the standard Medicare rate, which can be as low as 80 percent of real costs.

HealthcareDive reports that program requires that the participating hospitals have fewer than 51 acute-care beds, provide 24-hour emergency services and not be considered a critical-access institution.

The news service notes: “Rural hospitals have been especially hit hard in recent years because of dwindling reimbursements. Since 2010, 80 rural hospitals have closed and 673 are at risk of closing — 210 of which are at “extreme risk,” according to iVantage Health Analytics.

“In addition to lower reimbursements, patient admissions are also down as more patient care shifts to outpatient settings. Plus, President Donald Trump’s fiscal year 2018 budget proposal calls for $627 billion cuts from Medicaid over a decade. That could serve as a potential death knell for rural

The Centers for Medicare & Medicaid Services has announced that starting in 2019, the federal government will expand the Medicare Advantage value-based insurance design model to an additional 15 states and broaden the options available for participants. The expansion will mean that the model will be used in a total of 25 states in 2019.

The program began back in 2015, with the idea of letting MA plans offer custom-designed supplementary benefits for beneficiaries with such conditions as hypertension, diabetes and congestive heart failure.

The CMS will let insurers propose their own systems or methods for identifying eligible enrollees, including Medicare beneficiaries who have different chronic conditions than those previously set by the CMS.

The Houston Chronicle looks at how large physician groups gouge patients by avoiding accepting insurance so that they can charge two to three times more than they otherwise could in hospital emergency departments.

“Hospital administrators, who contract out emergency department staffing, know these doctors don’t accept the same insurance they do, but they allow those doctors to run the ED anyway,” The Chronicle’s Chris Tomlinson writes.

Medscape reported that emergency physicians make on average $339,000 a year.

“Out-of-network emergency departments are hugely profitable. That’s why hospitals have billboards along major highways that advertise the current waiting time in their EDs. It’s why stand-alone emergency rooms have opened in strip malls across the state {Texas}. Emergency medicine generates huge bills and high margins, as long as doctors don’t agree to insurance company rates,” writes Tomlinson.

This Bloomberg News podcast suggests that hospitals “could be dealt a financial blow under congressional Republicans’ attempts to overhaul federal tax law due to increased taxes on employees and automatic cuts to Medicare. Bloomberg Law’s Mike Stankiewicz discusses it with Nancy Lyons in the Bloomberg 99.1 Washington newsroom.”

Gwen MacKenzie, senior vice president of Ascension Healthcare, argues in Hospital Impact that narrow-network health-insurance plans are good for patients, providers and insurers as the sector moves to value-based payment models. After all, larger networks are associated with higher costs. Sheis senior vice president of Ascension Healthcare and ministry market executive of Ascension Michigan.

“The shift to value-based care is shaped by the idea that more fragmented care results in challenges to appropriate care delivery. Nationwide, disjointed care channels are preventing providers from reaching the quadruple aim: exceptional health outcomes, an exceptional experience for the people we serve, and an exceptional experience for providers, at an affordable cost.

“The ability to truly execute the quadruple aim depends on having an individual receive care within a defined network. The advantage of more targeted choice in narrow network plans is that providers can deliver quality across the continuum of care while being responsible stewards of resources.”

“Physician collaboration and established clinical protocols are made easier under narrow network plans built around a comprehensive provider network of highly qualified and trained providers. These plans operate within value-based contracts that direct consumers to participating physicians and hospitals.”

Reuters has surveyed the costs to hospitals of the increasing problem of physician burnout. Among the observations in its article:

“Some leading healthcare executives now say the way medicine is practiced in the United States is to blame {for increased burnout}, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.”

“Hospitals are just beginning to recognize the toll of burnout on their operations.

“Experts estimate, for example, that it can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.”

“In July, the National Academy of Medicine (NAM) called on researchers to identify interventions that ease burnout. Meanwhile, some hospitals and health insurers are already trying to lighten the load.

“Cleveland Clinic last year increased the number of nurse practitioners and other highly trained providers by 25 percent to 1,600 to handle more routine tasks for its 3,600 physicians. It hired eight pharmacists to help with prescription refills.

“Insurer UnitedHealth Group, which operates physician practices for more than 20,000 doctors through its Optum subsidiary, launched a program to help doctors quickly determine whether drugs are covered by a patient’s insurance plan during the patient visit. It is also running a pilot program for Medicare plans in eight states to shrink the number of procedures that require prior authorization.”

“Pre-approval requirements from health insurers for many services and quality metrics built into Obamacare have added to doctors’ administrative duties.”